Nursing Care Plan for Peptic Ulcer

Peptic ulcer is an acute or chronic ulcertation of the mucosa and deeper structures of the stomach, duodenum, lower esophagus, or jejunum. Chronic type may cause erosion followed by fibrosis of tissue over long periods of time. Causes may be an imbalance in acid and enzyme secretion that affects the protective barrier of the tract, drug ingestion that disrupts the protective barrier, severe emotional or prolonged stress. This plan may be used in association with gastrectomy care plan.

Nursing Diagnosis: Pain related to physical injuring agents of ingestion of irritants, increased gastric secretions, and effect on ulcerated area.

Expected Outcomes: Pain episodes reduced and controlled evidenced by verbalizations that pain is alleviated.

Nursing intervention with rationale:
I. Assess for:
A. Epigastritic pain following ingestion of irritating foods, time of onset after meals, other factors that increase or decrease pain.
Rationale: Symptoms of ulcer depending on site (pain 1-2 hours after meals in gastric ulcer; 2-4 hours in duodenal ulcer).

B. Bloated or gaseous feeling.
Rationale: Occurs with gastric ulcer.

II. Administer:
A. Antacid (aluminum hydroxide, magaldrate).
Rationale: Acts to relieve pain and enhance healing by protecting mucosa by neutralizing acid.

B. H2 Antagonist (cimetidine, ranitidine).
Rationale: Acts to decrease HCL secretion.

C. Anticholenergic (propantheline, belladona, and phenobarbital).
Rationale: Acts to decrease hypermotility and acid secretion.

D. Protective agent (sucralfate).
Rationale: Acts to coat and protect mucosa and inhibit pepsin activity on mucosa.

E. Gastric motility and emptying agent (metoclopramide).
Rationale: Acts to prevent retention of contents in stomach that stimulated acid production.

III. Teach patient or family:
A. Avoid raw, spicy, hot or cold foods, coffee, tea, cola drinks, alcoholic beverages.
Rationale: Increase acid production.

B. Avoid smoking, taking aspirin or other over-the-counter medications.
Rationale: Increases acid production and bleeding tendency of stomach mucosa.

C. Stress reduction techniques.
Rationale: Reduces acid production when relaxed; prevents pain.

D. Proper administration of medications including dose, time, frequency, side effects, expected outcomes.
Rationale: Promotes healing and prevents recurrence of ulcer or continued erosion of mucosa.